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Talking PDO Threads with Dr. Sheila Barbarino of Barbarino Surgical Arts

Well, I think you did such a great job, Stacey. Thank you for having me.  I work out of Austin, Texas and in Los Angeles, California.  It’s interesting, my journey with PDO Threads, I think that I’ve been doing threads for probably about three and a half years now. And I am a surgeon first and foremost. So initially, when PDO Threads came to the market, you know, I think all of us surgeons were kind of like, why would we want anything to do with those because we operate, right? So why not give our patients those results that they want and especially since I have the Austin and Los Angeles practices, they’re two very, very different patient populations. And one that has really made me evolve and really pushed me to kind of spread my wings as a cosmetic surgeon and as a doctor in general. So my Los Angeles office is more surgically minded, I think the patients come in knowing that they want surgery that they want to go under the knife, they’re okay with that, they’re okay with the downtime. They know that, you know, their friends have done it, and their family members have done it, and they’re ready to do it. So I think that my Austin population, and I think Austin in general, the community is less accepting of the actual surgery bit.  I think everybody wants to look fantastic, and just like they do in LA and everywhere else in the world, right. But I think they are not as willing to go under the knife.

You bring up a good point, just about geography and the different needs and different trends that are out there for everybody. So when you looked at bringing threads into your practice, particularly as a skilled plastic surgeon, how did you really approach integrating threads into your practice?

So for those of you who know me, I am an aggressive doctor in general. And I think that, you know, as a woman, if I don’t see a big difference, and if my patients wouldn’t see a big difference and appreciate the results that I’m just not going to bring it into my practice is a waste of time for them. It’s a waste of time for me, it’s a waste of time for us to offer it. And on top of everything, you know, I put my name on that result. And whatever that result, I give that patient you know, I have to own right.  It’s my work. So when I first started doing threads early on, I tried them. And I told the patients that we’re trying them or whoever we’re doing them on and I didn’t, I wasn’t really getting those fantastic results that I would have hoped. And in no way do I get facelift results with threads. It’s not that.  But one thing is they always say that it’s between the needle and the knife, which I think is a very nice kind of happy medium. And you know, all of us. If you guys follow me on Instagram or Facebook, one thing that I talked about the other day was there’s this overfilled syndrome. So patients, you know, come in every single day, I think anyone over 30 has understood their pain of having jowls, you know it or their lower face and hating their lower face. All of us do and when we come in to, you know, the plastic surgeon what we you know, when people come to see me they say, I said what do you what do you not like about yourself and I can honestly say 90% of the female patients come in and they’re like, I don’t like my jowls. I don’t like my lower face. You know, there’s always a zillion other problems but that’s a really big main concern. Especially as a facial plastic surgeon, that’s what we get every day, right? And the problem is, that in the past, you know, we always, say let’s put some filler in, and everybody wants them completely gone, right? It’s like, you know, you kind of give somebody a little bit of a taste of chocolate, and then they want the whole cake, right. So they start seeing a little bit of their jowls go away, and then they’re like, let’s do more, let’s, let’s do more filler, let’s get rid of all of it. I don’t like it at all. I don’t want to even see them. I don’t want to shadow it.  And what I really like about threads is when I approach a face, in a surgical setting, I do a facelift, I reposition skin and muscle fascia. And I reposition it with sutures, and cuttings, mass and all that stuff that we don’t want to talk about. So then, and then I often times do fat transfer to replace volume. And, you know, that’s when I get a really, you know, a very natural, very youthful result. And that’s, I think, the best way. So I feel like if you just do fat transfer, and if you just do surgery, it really isn’t your best result, right? So why would I do anything different?  So in my practice, the place for threads is when I’m repositioning skin, and then adding volume with filler. So that’s kind of my sweet spot. And that’s what I really love about PDO threads and that’s how I really approach most of my patients. Because, you know, I think that there’s certainly a place for PDO threads. And I think there’s certainly a place for filler. And so that’s, I think, you know, if a patient’s not ready for surgery, and you know, filler can only do so much and you know, the last thing I want patients to do is look like, you know, marshmallow pillow face or elephant syndrome and so I think that that’s where PDO threads really come in and do kind of really amazing things.

So Sheila, I’ve heard you speak multiple times that some of the keynote conferences across the US. And one of the things I’ve heard you talk about is the use of combination therapies. So I’m gonna guess your answer already. But my question is, how, or what has fundamentally changed with threads, since you started using them three and a half years ago.

I love to add structure, and to you know, everybody wants a lift, and everybody wants a contour. And I think it really just takes my filler and non-evasive results to the next. So whether I’m doing a tightening procedure with a laser or whether I’m doing out with Althera or I’m doing a radio frequency micro needling or Morpheus, whatever it is, either way, everybody could use some threads, everybody could use a little bit of filler, right? If they have you even young people that, you know, are just genetically unblessed, right, unfortunately, so you know, all of us have our little issues that even as stunning as you can be, there’s always one area of your face that you’re like, I look a little tired here, and I could use a little bit of rejuvenation. So I think that the PDO threads have been a game changer. And I think that they’re going to continue to be a game changer.  It’s like I said, in the beginning, I wasn’t really super psyched on, you know, the great results, because I wasn’t getting those great results. Like you know, I want a home run, I want predictability, I want the same reproducible results on you know, whatever patient it is, right. And I think that when you guys, all of you guys started bringing some really good threads to the, to the forefront, and really up’d the game, right?  All of a sudden, now they’re lasting longer, they’re pulling tighter, they are maneuvering better, they’re less painful, there’s less downtime. So I’ll be honest, there are so many patients, as you know, more and more patients are coming in and they’re like, I have a hot date tonight. You know, I don’t want to have my jowls, you know, showing tonight or let’s do something with my face, I have a date tonight and I don’t want anyone to know, I actually reach for my PDO threads more than my filler now because I think the threads can often hide the area that you place, you know, with the actual thread and then you don’t really get that much bruising.

Yeah, yep. One of the great benefits Absolutely.

Well, they can’t chew a big steak.

No hamburgers, please!  Don’t get your thread left and then go on a hot date and eat steak that night, you’re gonna be miserable.

Which, which leads me actually to the next question, what would you say is the most important lesson you’ve learned throughout your threading career in the last three and a half years?

There are a couple things that, you know, just like filler. There’s a learning curve. I think anybody who is starting off doing PDO threads, you’ll get it. I don’t I want to discourage you to try it. Because I think that it really has really done wonders for my noninvasive results. But I think that it really, when I asked my patients, you know, what do you like about the PDO Theads, they noticed that they’re looking more natural, it’s not as painful as they thought it was going to be, and their results are just really the next level.  That’s what I love.

And I appreciate you, especially as a manufacturer, I appreciate you bringing up the learning curve, because it that’s a very real thing for any modality. We make it so simple for you. It’s not a paint by numbers technique. And every patient is so unique and specific, which is one of the benefits of Les Encres threads with the vast selection of threads that we have. But it is also for some overwhelming and a hindrance because you don’t know where to start. And with the learning curve in place, it can be scary. So I appreciate you bringing that up,  the importance of training and education in practice, practice practice!

Ah, so I mean, I think I’m going to tell all of you who are thinking about doing threads, you know, don’t feel bad about yourself to everyone’s, there’s always someone that’s very stern, to superficial thread, I’ve done it myself. I don’t think anybody who hasn’t that does threads is lying. They’re big that liars. E But the good part is, is that they really are easy, you can easily get it out. And on top of that, you know, 99.9% of the complications are easily resolved. And you don’t really even have to pull them out. I think, really, how many threads have people actually had to pull out? But they’re very few? I think I really had to do one. One, and it was just because the patient had an event. You know, a lot of times like the dimpling or, you know, often goes away within two weeks.

Right, right. So I want to switch gears here just a little bit with you having a practice in the Los Angeles area, and then one in Austin, Texas, you’ve already noted some of the differences between just the populations. What would you say are some of the biggest business challenges you have right now, whether in Los Angeles or Austin? Are there trends or kind of a theme that you’re seeing that’s a little bit of a challenge for you and your team?

Well, every month is a different challenge right now, right? I don’t think anybody, anybody that has been practicing in 2020 and 2021, every single month, it’s like a different thing. Right? I mean, I think that in my LA and Austin office right now, we are trying to forge ahead and really get all of our surgery, surgeries done as soon as possible because we are concerned that the Delta variant, as well as the lambda and the mu, I’m not going to go through the whole Greek alphabet. You know, it’s going to rear its ugly head and whether or not they shut us down or whether or not they put off elective surgery. That’s obviously a huge concern for all of us. I think in LA, that’s more of a chance of them shutting us down. Because of the politics there. But in Austin, we’re kind of wide open, but the problem is, is that not as many Austinites are as vaccinated.   Everyone needs to take responsibility and hopefully get vaccinated. But, everyone has their own belief set, and we can’t really push that on anybody. We’re trying to be respectful. I think that one thing that last night, we had a conversation with a couple of my colleagues was that we’re seeing a lot less patients that are spending a lot more money, which I think is kind of interesting. That’s the dream. That’s what we always wanted to do, right? We wanted to see, you know, have a half day and you know, make a full day of patient payments. So, you know, that, I think is what a lot of us are seeing more of I’m not sure if it’s because the stock market is doing well, I don’t know if people are not vacationing and so they have more money. I’m not sure what it is. Are you seeing that as well?

We are. We absolutely are experiencing the rise in business, from our standpoint is phenomenal. Not just from the Les Encres brand catching fire across the US. But the threading treatment itself is really becoming a mainstream treatment to have done where before, it was a little controversial.

You’re 100% right. So I’ve heard, I know that you’ve heard me talk about the kind of the, the ick factor with the PDO threads.  Patients come in, and they’ll say, you know, just the thought of having a threaten me, it’s kind of, you know, and, you know, they are dissolvable, they are safe, they are temporary, you know, and they stimulate collagen in the areas that they dissolve so you lift them up with the PDO or PLLA or PCL, whatever you’re using, and then the lift is sustained by the collagen.  And so it’s, it’s a beautiful process, right? It’s using our own natural mechanisms that can actually make us look more youthful and fantastic, which is the dream. So I think that right now people are kind of getting around the ick factor, because now they’re seeing their friends. And now they’re seeing more and more people do it. And now it’s becoming more and more mainstream. And I think, like I said, I think that this is just the beginning of the threat explosion.

One of the things that we have found, too, is now that there’s a more mainstream acceptance of threads, just in general from injectors, I think a lot of people are starting to understand that, while the lifting threads have a lot of sizzle on Instagram, and a lot of sizzle, to get people immediate results. But the proof in the pudding really is in the mono in the screw threats. Now, those are so minimally invasive. So just basic bread and butter thread treatments that you can do that increase the profitability of an account. But more importantly, increase patient satisfaction without having to have the ick factor.

I love the mono and the screw threads to be used a basket, who doesn’t hate their double chin, who doesn’t have some skin laxity on here, I mean, all of us, you know, the zoom neck, whatever you want to call it, it’s miserable. We fight it every day. People don’t realize what a difference it can make.  We’ve gotten so into this place of putting more and more jaw filler and more chin filler, and we’re really masculinizing a lot of these beautiful women. Right? And that’s the last thing you want to do. So what I suggest is if you’ve done their chin, if you’ve done their jaw line, and they still need some more definition between their face and their neck, try the mono and screw threads,  there really is very little downtime, number one and number two, you get really immediate results. Right?  And then stimulation over time, which is the dream right? And it doesn’t hurt. It’s not very painful and you don’t feel that poke for a couple days. And you can go out and have that steak if you really want to some red meat tonight.

Putting filler more and more in the forehead and the glabella, and here’s the thing is that that’s a very, very scary area to be injecting filler in, as seasoned or as experienced as you are, you know anybody getting putting filler there all the time gets a little anxious.  It’s kind of like the nose area, you know, which is again, another area that Les Encres has a great thread to put in, the nose. So if you’re literally losing your lunch every time you’re putting filler in noses or in the forehead, or the glabella. The mono and screw threads are great.

I’m glad you brought that up. Question of the hour PDO, PLLA or PCL threads, which is your go to favorite choice?

I use them for different reasons. So with the PDOs I reach for when the patient comes in, and they want a big lift, and I really want that wow factor and I want that chiseled jaw.  So, you know, that’s the snatched jawline, that uplifted shape, you know, when you really want that big pull. And that really impressive.  What I like about the PLLA and PCL  is that this is going to build the structure over time. You don’t get as much of that, wow, initially, you do get some but not that, like, Oh my gosh, you know, I want my, you know, forehead up to here forever, I want you to that initial, there’s nothing like giving a patient right after and they look in a mirror and they’re like, wow, this is what I used to look like.  PLLA and PCLs are wonderful threads as well. But, you know, they really develop their wow factor over time. So, you know, if we can just kind of do a mix of both of them.

So for listeners who are able to see the video, Sheila has a beautiful pink gown on and she is dressed to go to a black tie event this evening in Austin, Texas. So it begs the question, how do you juggle? What is your life hack for juggling your schedule?

I multitask very poorly. Like I mean, that’s it’s so crazy. I think I run around on empty all day long. You know, I wake up and I’m five minutes late.  I think that number one, someone told me a long time ago that as long as you’re really focused on what you’re doing at the time you’re doing it, then regardless of how many things you’re doing, you’re going to be good at what you’re doing. Right. One thing that I hate personally, and you do this very well is that when you’re speaking with someone, or when you’re connecting with someone, you are really listening to what they’re saying, and you are in this conversation, you know, and when I’m in a room with a patient, or I’m taking a phone call or doing a podcast, I need to be in this moment and not worried about whether everybody’s gonna get here on time. And you know, what’s going on tonight, so I think that’s very, very important. I think that when people spread themselves really thin the way they’re always oftentimes people try to stay ahead of the anxiety by trying to figure out, what’s the next step and I think that doing that is where you trip up, because that’s where you lose your authenticity and you lose your connection. The reason why I’m doing this is because I wanted to be here, I want to be part of your podcast, I think it’s something that the world is really interested in, in PDO threads and I love that you’re, a strong female that’s the owner of your own company for this amazing thread company. So, you know, I certainly want to support and I want to be a part of that and I have been which has been amazing and so thank you for bringing your broadcast to me Yeah,

No, thank you, Sheila, where can people find you when you’re not running around on empty? Where are you on social media? What’s your handle? Where can they find Barbarino Surgical Arts?

Barbarrinosurgicalarts on Instagram

That’s excellent. And before we let you run off to your evening, last question, what is the most important thing you’ve learned in life thus far?

Be good to people because, you know, they’re gonna be good to you and the people that aren’t, you know, it comes around, even if not this time, maybe there are a lot of people that are takers, and there are a lot of people that are givers and there’s going to be a lot more givers and you know, at some point, you’re going to put that energy out there and it’s going to come back to you.